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Incidence of surgical rib fixation at chest wall injury society collaborative centers and a guide for expected number of cases (CWIS-CC1)

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Surgical stabilization of rib fractures (SSRF) improves outcomes in certain patient populations. The Chest Wall Injury Society (CWIS) began a new initiative to recognize centers who epitomize their mission as CWIS Collaborative Centers (CWIS-CC). We sought to describe incidence and epidemiology of SSRF at our institutions.

Methods

A retrospective registry evaluation of all patients (age > 15 years) treated at international trauma centers from 1/1/20 to 7/30/2021 was performed. Variables included: age, gender, mechanism of injury, injury severity score, abbreviated injury severity score (AIS), emergency department disposition, length of stay, presence of rib/sternal fractures, and surgical stabilization of rib/sternal fractures. Classification and regression tree analysis (CART) was used for analysis.

Results

Data were collected from 9 centers, 26,084 patient encounters. Rib fractures were present in 24% (n = 6294). Overall, 2% of all patients underwent SSRF and 8% of patients with rib fractures underwent SSRF. CART analysis of SSRF by AIS-Chest demonstrated a difference in management by age group. AIS-Chest 3 had an SSRF rate of 3.7, 7.3, and 12.9% based on the age ranges (16–19; 80–110), (20–49; 70–79), and (50–69), respectively (p = 0.003). AIS-Chest > 3 demonstrated an SSRF rate of 9.6, 23.3, and 39.3% for age ranges (16–39; 90–99), (40–49; 80–89), and (50–79), respectively (p = 0.001).

Conclusion

Anticipated rate of SSRF can be calculated based on number of rib fractures, AIS-Chest, and age. The disproportionate rate of SSRF in patients age 50–69 with AIS-Chest 3 and age 50–79 with AIS-Chest > 3 should be further investigated, as lower frequency of SSRF in the other age ranges may lead to care inequalities.

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Author information

Authors and Affiliations

  1. Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Drive CSB 420, MSC 613, Charleston, SC, 29425, USA

    Evert Austin Eriksson & Leanna Clevenger

  2. Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands

    Mathieu Mathilde Eugene Wijffels & Esther M. M. Van Lieshout

  3. Department of Trauma, Overland Park Regional Medical Center, 10500 Quivira Rd., Overland Park, KS, 66215, USA

    Adam Kaye

  4. Department of Surgery, Stanford Healthcare, Chest Wall Injury Center, Stanford Healthcare, Center for Innovation in Global Health (CIGH), Stanford University, Stanford, USA

    Joseph Derek Forrester, Jamie Tung & Michelle Woodfall

  5. Department of Surgery, Saint Francis Hospital and Medical Center, UConn School of Medicine, Hartford, CT, USA

    Manuel Moutinho, Thomas Russell Hill & Andrew Ross Doben

  6. Department of Trauma, Intermountain Health, Salt Lake City, USA

    Sarah Majerick & Thomas William White

  7. Trauma Surgery, Surgical Critical Care, Emergency General Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, TraumaOmaha, NE, 68198-3280, USA

    Zachary Mitchel Bauman

  8. Section of General Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA

    Christopher Francis Janowak

  9. Gold Coast University Hospital, Gold Coast, QLD, 4215, Australia

    Bhavik Patel

  10. Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Martin Wullschleger

  11. Griffith University, Gold Coast, Australia

    Martin Wullschleger

Authors
  1. Evert Austin Eriksson
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  2. Mathieu Mathilde Eugene Wijffels
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  3. Adam Kaye
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  4. Joseph Derek Forrester
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  5. Manuel Moutinho
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  6. Sarah Majerick
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  7. Zachary Mitchel Bauman
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  8. Christopher Francis Janowak
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  9. Bhavik Patel
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  10. Martin Wullschleger
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  11. Leanna Clevenger
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  12. Esther M. M. Van Lieshout
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  13. Jamie Tung
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  14. Michelle Woodfall
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  15. Thomas Russell Hill
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  16. Thomas William White
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  17. Andrew Ross Doben
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Contributions

EAE, ARD, and JDF participated in the literature search. EAE, MMEW, AK, ARD, JDF, SM, ZMB, CFJ, BP, and MW participated in the study design. EAE, MMEW, AK, ARD, JDF, SM, ZMB, CFJ, BP, MW, MM, LC, SC, EMMVL, JT, MW, RH, and TW participated in data collection. EAE performed the data analysis. EAE, MMEW, AK, ARD, JDF, SM, ZMB, CFJ, BP, and MW participated in data interpretation. EAE and ARD drafted the article. EAE, MMEW, AK, ARD, JDF, SM, ZMB, CFJ, BP, MW, MM, LC, SC, EMMVL, JT, MW, RH, and TW participated in critical revisions. All authors approved the final article version for submission.

Corresponding author

Correspondence to Evert Austin Eriksson.

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Conflict of interest

EAE—Speaker for DePuy Synthes. Dr. Forrester has received unrestricted research funding from Varian for an investigator-initiated clinical trial (https://clinicaltrials.gov/ct2/show/NCT04482582) and received grant funding from the Surgical Infections Society. Neither of these lead to conflicts of interest for this work product. JT: No disclosures. MEW: No disclosures. MMEW—Ad hoc advisor for Johnson & Johnson DePuy Synthes, Research funding Johnson & Johnson DePuySynthes, Research funding Osteosynthesis and Trauma Foundation (OTC). MEW(Wullschleger): Ad hoc advisor for Johnson & Johnson DePuySynthes. AK (Kaye): Lecturer Zimmer/Biomet, and Atricure. AD: Past consultant for DePuy Synthes, KLS-Martin, Zimmer-Biomet. No current relationships related to this project. BP: no disclosures. EMMVL—No disclosures. ZMB: Paid educational consultant for Zimmer-Biomet, KLS-Martin, and Atricure. LC no disclosures. SC no disclosures. SM—none. CJ—none. TRH—none. MM—none.

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Eriksson, E.A., Wijffels, M.M.E., Kaye, A. et al. Incidence of surgical rib fixation at chest wall injury society collaborative centers and a guide for expected number of cases (CWIS-CC1). Eur J Trauma Emerg Surg 50, 417–423 (2024). https://doi.org/10.1007/s00068-023-02343-4

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